COMPUTER-AIDED QUANTITATIVE EARLY DIAGNOSIS OF DIABETIC FOOT

Diabetes is an incurable metabolic disease characterized by high blood sugar levels. The feet of people with diabetes are at the risk of a variety of pathological consequences including peripheral vascular disease, deformity, ulceration, and ultimately amputation. The key to managing the diabetic foot is prevention and early detection. Unfortunately, current hospital centered reactive diabetes care and the availability of inadequate qualitative diagnostic screening procedures causes physicians to miss the diagnosis in 61% of the patients. We have developed a computer aided diagnostic system for early detection of diabetic foot. The key idea is that diabetic foot exhibits significant neuropathic and vascular damages. When a diabetic foot is placed under cold stress, the thermal recovery will be much slower. This thermal recovery speed can be a quantitative measure for the diagnosis of diabetic foot condition. In our research, thermal recovery of the feet following cold stress is captured using an infrared camera. The captured infrared video is then filtered, segmented, and registered. The temperature recovery at each point on the foot is extracted and analyzed using a thermal regulation model, and the problematic regions are identified. In this thesis, we present our research on the following aspects of the developed computer aided diagnostic systems: subject measurement protocols, a trustful numerical model of the camera noise and noise parameter estimations, infrared video segmentation, new models of thermal regulations, thermal patterns classifications, and our preliminary findings based on small scale clinical study of about 40 subjects, which demonstrated the potential the new diagnostic system

Efektivitas Edukasi Video Deteksi Dini Ulkus Kaki Terhadap Tingkat Pengetahuan Pasien Diabetes Di Prolanis Sragen

Diabetes mellitus is a chronic disease characterized by elevated glycemia levels due to abnormalities in insulin secretion and will have an impact on complications, one of the complications is diabetic foot ulcers. Counseling on early detection of ulcers in patients in prolanis has never been done. Education is used to improve people's knowledge and ability to early detect diabetic foot ulcers. There are several methods that can be done in providing information, one of which is by using video media. Objective: to determine the effectiveness of early detection education of foot ulcers on the level of knowledge of diabetic patients in prolanis sragen. Research design: quantitative research with quasi-experimental design design with nonequivalent post-test pre-test research design group design. The samples taken were 58 patients, of which 29 were in the experimental group and 29 as the control group. The sampling technique uses purposive sampling. Results: Independent test t-test = 0.003 < 0.05, it can be concluded that Ha is accepted which means there is a significant difference between the post-test results of the experimental group and the post-test of the control group. The results of the paired sample test = 0.003 < 0.05 can be concluded that Ha received there was an influence of early detection video education of foot ulcers on the level of knowledge in the experimental group. Suggestion: it is hoped that it can be used as a source of information and education about early detection of foot ulcers so that it can make efforts to increase knowledge and efforts to prevent the occurrence of diabetic ulcers

Detection of Diabetic Foot Using Statistical Features

Diabetes is a serious threat to universal health that respects neither socioeconomic rank nor nationwide boundaries. Diabetic foot and lower extremities problems, which affect 40 to 60 million people with diabetes universally, are a significant source of morbidity in people with diabetes. Conducting regular screening and risk stratification for at-risk feet can be greatly used for the management of blood glucose levels. Recent studies revealed that qualitative evidence can be attained using temperature variations from the thermogram of the plantar foot. The changes in temperature distribution are vital in the investigation of diabetic foot, which assist in the early detection of foot ulceration. The main objective of this work is to perform statistical analysis of diabetic foot to draw reasonable and accurate inferences. Besides, there is no gold standard method in classifying the plantar thermal images into any particular group. This may be conquered by quantitatively analyzing the temperature distributions in each foot separately. Since, plantar thermal images are colored in nature, certain color statistical features which are statistically more significant are added with the quantitative temperature distribution to develop an efficient machine learning method to prognosticate the likelihood of diabetes in patients with maximum accuracy is explored

The Veterans Affairs Neuropathy Scale: A Reliable, Remote Polyneuropathy Exam.

Introduction: Polyneuropathy (PN) complaints are common, prompting many referrals for neurologic evaluation. To improve access of PN care in distant community clinics, we developed a telemedicine service (patient-clinician interactions using real-time videoconference technology) for PN. The primary goal of this study was to construct a remote exam for PN that is feasible, reliable, and concordant with in-person assessments for use in our tele-PN clinics. Methods: To construct the VA Neuropathy Scale (VANS), we searched the literature for existing, validated PN assessments. From these assessments, we selected a parsimonious set of exam elements based on literature-reported sensitivity and specificity of PN detection, with modifications as necessary for our teleneurology setting (i.e., a technician examination under the direction of a neurologist). We recruited 28 participants with varying degrees of PN to undergo VANS testing under 5 scenarios. The 5 scenarios differed by mode of VANS grading (in-person vs. telemedicine) and by the in-person examiner type (neurologist vs. technician) in telemedicine scenarios. We analyzed concordance between the VANS and a person's medical chart-derived PN status by modeling the receiver operating characteristic (ROC) curve. We analyzed reliability of the VANS by mixed effects regression and computing the intraclass correlation coefficient (ICC) of scores across the 5 scenarios. Results: The VA Neuropathy Scale (VANS) tests balance, gait, reflexes, foot inspection, vibration, and pinprick. Possible scores range from 0 to 50 (worst). From the ROC curve, a cutoff of &gt;2 points on the VANS sets the sensitivity and specificity of detecting PN at 98 and 91%, respectively. There is a small (1.3 points) but statistically significant difference in VANS scoring between in-person and telemedicine grading scenarios. For telemedicine grading scenarios, there is no difference in VANS scores between neurologist and technician examinations. The ICC is 0.89 across all scenarios. Discussion: The VANS, informed by existing PN instruments, is a promising clinical assessment tool for diagnosing and monitoring the severity of PN in telemedicine settings. This pilot study indicates acceptable concordance and reliability of the VANS with in-person examinations

Use of m-Health Technology for Preventive Interventions to Tackle Cardiometabolic Conditions and Other Non-Communicable Diseases in Latin America- Challenges and Opportunities

In Latin America, cardiovascular disease (CVD) mortality rates will increase by an estimated 145% from 1990 to 2020. Several challenges related to social strains, inadequate public health infrastructure, and underfinanced healthcare systems make cardiometabolic conditions and non-communicable diseases (NCDs) difficult to prevent and control. On the other hand, the region has high mobile phone coverage, making mobile health (mHealth) particularly attractive to complement and improve strategies toward prevention and control of these conditions in low- and middle-income countries. In this article, we describe the experiences of three Centers of Excellence for prevention and control of NCDs sponsored by the National Heart, Lung, and Blood Institute with mHealth interventions to address cardiometabolic conditions and other NCDs in Argentina, Guatemala, and Peru. The nine studies described involved the design and implementation of complex interventions targeting providers, patients and the public. The rationale, design of the interventions, and evaluation of processes and outcomes of each of these studies are described, together with barriers and enabling factors associated with their implementation.Fil: Beratarrechea, Andrea Gabriela. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Diez Canseco, Francisco. Universidad Peruana Cayetano Heredia; PerúFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Miranda, Jaime. Universidad Peruana Cayetano Heredia; PerúFil: Ramirez Zea, Manuel. Institute of Nutrition of Central America and Panama; GuatemalaFil: Rubinstein, Adolfo Luis. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Gambaran Risiko Ulkus Kaki Pada Penderita Diabetes Mellitus Di Wilayah Solo Raya

Diabetes mellitus is a disorder of carbohydrate, fat and protein metabolism characterized by high blood sugar levels and an increase every year. The number of diabetes mellitus sufferers in the Solo Raya region has increased, as many as 75.185 people in 2018 and as many as 139.201 people in 2019. The large number of cases of diabetes mellitus that occur if not managed properly can cause various complications, one of which is diabetic foot ulcers. Early detection of foot ulcers is an important effort that aims to determine the risk of foot ulcers and to assess foot abnormalities of people with diabetes mellitus early, so that early action can be taken to save the lower extremities. This study aims to describe the risk of foot ulcers in diabetes mellitus sufferers in the Solo Raya region. This type of research is quantitative with a descriptive survey research design. The population of this study were all people with diabetes mellitus in the Solo Raya region totaling 139.201. The research sample was 100 samples with accidental sampling technique. Data collection using an online questionnaires and data analysis with frequency distribution. This study concludes that the characteristics of diabetes mellitus sufferers in the Solo Raya region are mostly 41-60 years old, female, have high school education/equivalent, work as a housewife, the majority of type 2 diabetes mellitus, most of them have diabetes mellitus >5 years, live in Sukoharjo district and the risk level of foot ulcers mostly has a high risk of foot ulcers namely 51%. Suggestions for the public especially those suffering from diabetes mellitus should routine early detection to determine the risk of foot ulcers so that they can prevent foot ulcers

Duration of type 2 diabetes is a predictor of elevated plantar foot pressure

AIMS: Elevated plantar pressure is considered a significant risk factor for ulceration in diabetes mellitus. The aim of this study was to determine whether duration of diabetes could affect plantar pressure in patients with no known significant comorbidity or foot pathology.METHODS: Participants with type 2 diabetes, but without known confounding factors that could alter peak pressure, were matched for age, weight, and gender and categorized into 3 groups of diabetes duration: group 1 (1-5 yr), group 2 (6-10 yr), and group 3 (11-15 yr). Plantar pressures were recorded utilizing a twostep protocol at a self-selected speed.RESULTS: One-way analysis of variance (ANOVA) revealed significant differences in mean peak plantar pressures between the three groups under the 2nd - 4th metatarsophalangeal joint (MPJ) region of interest (ROI) (p = 0.012 and p = 0.022, respectively) and left heel (p = 0.049). Also, a significant difference in mean pressure-time integral under the left 2nd - 4th MPJ ROI (p = 0.021) and right heel (p = 0.048) was observed. Regression analysis confirmed that mean peak plantar pressures in the first group (but not in the second group) were significantly lower than in the third group (p = 0.005).CONCLUSIONS: As the duration of diabetes increased, peak plantar pressure increased significantly under the 2nd - 4th MPJ ROIs. These findings suggest that clinicians should make more use of pressure mapping technology as part of their clinical management plan in patients with diabetes >10 yr, even if they have no complications or deformities, to preserve functional limbs in this high-risk population.peer-reviewe

Hyperglycemia and Hyperlipidemia Act Synergistically to Induce Renal Disease in LDL Receptor-Deficient BALB Mice

Diabetic nephropathy is the leading cause of end-stage renal disease in Western countries, but only a portion of diabetic patients develop diabetic nephropathy. Dyslipidemia represents an important aspect of the metabolic imbalance in diabetic patients. In this study, we addressed the impact of combined hyperlipidemia and hyperglycemia on renal pathology. Kidneys from wildtype (WT) or LDL receptor-deficient BALB/cBy mice (BALB. LDLR -/-) were examined at 22 weeks of age. Diabetes was induced by administration of streptozotocin and mice were randomly assigned to either standard chow or Western diet. Chow fed BALB. LDLR -/- mice did not demonstrate renal abnormalities, whereas BALB. LDLR -/- mice fed a Western diet showed occasional glomerular and tubulointerstitial foam cells. Diabetic WT mice had modestly increased glomerular cellularity and extracellular matrix. Hyperlipidemic and diabetic BALB. LDLR -/- mice exhibited an increase in glomerular cellularity and extracellular matrix, accumulation of glomerular and tubulointerstitial foam cells and mesangial lipid deposits. The tubular epithelium demonstrated pronounced lipid induced tubular degeneration with increased tubular epithelial cell turnover. Hyperlipidemia and hyperglycemia seem to act synergistically in inducing renal injury in the BALB. LDLR-/- mouse. This model of diabetic nephropathy is unique in its development of tubular lesions and may represent a good model for hyperlipidemia-exacerbated diabetic nephropathy. Copyright (C) 2004 S. Karger AG, Basel

Diabetic Neuropathy: A cross-sectional study of the relationships among tests of neurophysiology

OBJECTIVE — To determine the relationships among large, small, and autonomic fiber neurophysiological measures in a cross-sectional study of patients with diabetes. RESEARCH DESIGN AND METHODS — We assessed 130 individuals: 25 healthy subjects and 105 subjects with diabetes. Subjects were classified by the presence or absence of neuropathy by physical examination. All subjects underwent autonomic testing, nerve conduc-tion studies, quantitative sensory testing, and nerve-axon reflex vasodilation in addition to quantifiable neurological examination and symptom scores. Correlation and cluster analysis were used to determine relationships between and among different neurophysiological testing parameters. RESULTS — Results of neurophysiological tests were abnormal in patients with clinical evi-dence of diabetic neuropathy compared with results in healthy control subjects and in those without neuropathy (P 0.01, all tests). The correlations among individual tests varied widely, both within (r range0.5–0.9, NS to0.001) and between test groups (r range0.2–0.5, NS to0.01). A two-step hierarchical cluster analysis revealed that neurophysiological tests do not aggregate by typical “small, ” “large, ” or “autonomic ” nerve fiber subtypes